Section of Youth, Literacy and Skills Development, Education Sector, UNESCO
Launched in 2012 by the Indian organisation ZMQ Development, MIRA Channel is an integrated mobile phone service providing communication and information tools for maternal and child health care to rural women in low-resource settings. "The solution offers app-based modules referred to as ‘Channels’ related to a variety of topics, including ANC [antenatal consultations] and PPC, child immunization, family planning and adolescent health. The channels are intended to emulate television programming through audio recordings and multimedia content, to improve awareness and build knowledge on health issues, with a particular focus on mothers with low levels of literacy."
Through the UNESCO-Pearson Initiative for Literacy: Improved Livelihoods in a Digital World, this case study is part of a series highlighting how inclusive digital solutions can help people with low skills or low literacy levels use technology in ways that support skills development and, ultimately, improve livelihoods - in contribution to achieving the Sustainable Development Goal on education. For more information on the initiative, click here. Initially seeking to address India's maternal mortality rate (MMR) and under-5 years of age mortality rate, the MIRA Channel service has reached, as reported here, 850,000 women, adolescent girls, and children. It comprised originally the MIRA Channel App for individual use, the MIRA Channel Worker Toolkit for home visits by community health workers (CHWs), and an analytics dashboard called MIRA-PHC Connect for generating reports from MIRA Channel data. "This allows service providers to take timely action for reducing maternal and child mortality."
The study explains the three-tier health care system in rural India as: sub-centres feeding into primary health centres (PHCs), and PHCs feeding into community health centres (CHCs), each with increasing population coverage capacity. Sub-centres, intended to provide localised services, had, in 2015, one female CHW for 4,000 people and one male CHW for 15,000 people. ZMQ launched MIRA Channel as a pilot to "offset the shortfall in CHWs across rural India" through:
- training adolescents who had mobile phone experience to use MIRA Channel and help build the programme for themselves and their pregnant mothers and aunts - which led ZMQ to develop digital storytelling and social mobile games in a programme called "Game Lab", involving game design workshops integrating adolescent stakeholders through storyboard design on local issues and solutions which are then converted to digital games.
- training CHWs to use mobile phones to search contact lists and initiate calls, and send messages over SMS [text messaging].
- expanding the mobile platform using interactive graphics and voiceovers adapted to both feature phones and smartphones.
The expanded content is delivered across five subchannels: "prenatal care, neonatal care, child immunization, adolescent health (for girls), and family planning. MIRA Channel uses icons with audio support, making the service an interactive 'talking toolkit' designed for women and young people with low literacy skills. MIRA Channel also provides digital content by way of stories and mobile games to adolescent girls on issues related to water, sanitation and hygiene (WASH), menstrual hygiene, and dowries and early child marriage." CHW training, done by CHW master trainers in a cascading approach, includes basic device use and then literacy in using the toolkit, including registry of mothers and data recording, then patient analysis. "Training materials include large posters, live presentations and training manuals for volunteers to take home."
Since its inception, ZMQ has adapted MIRA Channel to multiple country contexts while maintaining community stakeholder engagement to ensure contextualised content delivery including graphics and messages in local languages. Country applications now include Uganda and Afghanistan. Graphic content feedback from community design sessions alerted ZMQ to subtleties of local visual preferences; for example, Afghan women preferred to see images of husbands with "charming" and smiling facial features, while Ugandans wanted to see CHW images as well-dressed with "headgear and medical equipment".
Expansion came from partnering and from human networks. For example, developing mobile-based solutions for micro-finance institutions in India gave access to low-literacy women who also began to use the maternal-child health (MCH) app, registering themselves to receive local language messages, followed by registering the baby's birth in order to receive immunisatoin information based upon appropriate child development timing. The developer intends to expand its content delivery to include a skills development channel with a variety of livelihood development training courses and capacity building tools for women and girls. In India, ZMQ is expanding educational content, including basic literacy content for learning to read and write in Hindi and English, as well as basic numeracy content. Another ZMQ training project called Ajeevika Connect provides basic content for learning how to code. Future training on the MIRA channel may include "soft-skills training, financial literacy, entrepreneurship training, and promotion and marketing training."
ZMQ has collaborated with telecom recharge kiosks and community radio stations. The recharge station employees help community members download the MRA Channel app, games, and stories to their phones. Radio stations promote the app and the service of recharge kiosks.
In the initial pilot district of Mewat, India, results include:
- "a 55 per cent increase in ANC consultations and 49 per cent increase in institutional deliveries, while child immunization rates have increased by 41 per cent....
- scaling of the model to 180 government-sponsored CHWs and 25 ANMs [Auxiliary Nurse Midwives] reaching 69,000 women."
In Uganda and Afghanistan, "66,000 and 43,000 women, children and girls are using the solution. Results have shown that almost 3,000 Uganda and 1,700 Afghani women have successfully completed their pregnancies using MIRA Channel. Another 10,200 Ugandan children and young women have received immunizations, with an additional 5,200 immunizations in Afghanistan."
Email from Hilmi Quraishi to The Communication Initiative on December 27 2017 and from Steven Vosloo on January 10 2018. UNESCO website, January 2 2018. Image credit: © ZMQ/Hilmi Quraishi